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Application for employment

Please complete the entire application below

Accessibility: If you need an accommodation as part of the employment process please contact Human Resources at (402) 359-2578 or email info@valleycorp.com. Valley Corporation requires pre-employment, random and post-accident drug testing in order to comply with the Federal Government “Drug-Free Workplace Act.” We are an Equal Opportunity Affirmative Action Employer, dedicated to equal employment for all qualified persons without regard to race, color, age, sex, religion, physical impairment or national origin. Valley Corporation has a priority system for hiring: (1) Re-Hires (2) Office References (3) Superintendent References (4) Employee Reference

Application for employement

Contact Information

First Name*

Last name*

Middle initial

Email address*

If you don’t have a valid email address, please use “Your First.Last Name@donotreply.com”.
Please understand that employers may not be able to contact you without a valid email.

Street Address*

Apt./Unit Number

City*

State*

Postal code*

Cell Phone Number*

Position Desired:*

Desired Salary*

Available Start Date*

Date Format: MM slash DD slash YYYY

Reference Source (Check one):

Newspaper

Job Service

Walk-in

Website

Other

Referral Name

Employed Now?

Yes

No

Applied with Valley Corp. before?

Yes

No

Are you at least 18 years old?

Yes

No

Are you a citizen of the U.S.?*

Yes

No

If no, are you eligible to work in the U.S.?

Yes

No

Have you ever been convicted of a felony or misdemeanor in the last 5 years?*

Yes

No

*You will not be denied employment solely
because of a conviction record, unless the
offense is related to the job for which you
applied.

If yes, please explain:

Education

Name/Location of School

High School

Graduated?

Yes

No

GED

College

Graduated?

Yes

No

College (additional)

Graduated?

Yes

No

Trade

Graduated?

Yes

No

Special studies relating to position you applied for:

License Information

State

License number

Type

Expiration

*Section 383.21FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”.*

Expiration date of current Medical Card

Date Format: MM slash DD slash YYYY

Have you ever been denied a license, permit or privilege to operation a motor vehicle?

Yes

No

Has any license permit or privilege ever been suspended or revoked?

Yes

No

If yes, please explain:

If yes, please explain:

ADD WORK EXPERIENCE

Work Experience

Previous Employment 2

Last Employer Company Name

Job Title

Start Date

Date Format: MM slash DD slash YYYY

End Date

Date Format: MM slash DD slash YYYY

Address

Phone Number

Salary

Reason for Leaving

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?

Yes

No

Was the previous job position designated as a safety sensitive function in any DOT regulated ode, subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40?